Chapter 74

### Key Points

1. Aortic thrombosis in neonates is usually a complication of umbilical artery catheterization, and its diagnosis can be confirmed by ultrasonography. Management options include anticoagulation, thrombolysis, and surgical thrombectomy, and choice of therapy should be individualized.

2. Abdominal aortic aneurysms in children are most commonly caused by infection, often in association with a history of umbilical artery catheterization.

3. The radiologic modalities used to define anatomic details of abdominal aortic aneurysms and guide surgical planning include magnetic resonance angiography, computed tomography angiography, and conventional aortography.

4. The decision to proceed with surgical repair of an abdominal aortic aneurysm is based on the likelihood of rupture or other complications.

5. Takayasu arteritis causes an inflammatory aortitis, characterized by an early acute phase and a late occlusive phase. Conventional arteriography has been the gold standard for diagnosis, but magnetic resonance arteriography is becoming the preferred technique in many centers.

6. Corticosteroids are used to treat the inflammation associated with Takayasu arteritis in its early phase and prevent the late occlusive complications. Surgical revascularization may be required and include aortoaortic bypass grafting or patch aortoplasty, with renal artery or visceral artery reconstruction.

7. Hypertension is the cardinal presenting feature of congenital abdominal aortic coarctation. Conventional aortography remains the gold standard for evaluating the location and extent of disease, with selective arteriography to determine involvement of the renal or visceral arteries.

8. The surgical approaches for repair of abdominal aortic coarctation are varied and individualized based on the location and length of the stenotic segment and involvement of renal arteries. Resolution of hypertension following surgical repair is reported in 95% of children.

9. Conventional abdominal aortogram with selective renal arteriography is the gold standard for diagnosing renovascular hypertension, which is surgically correctable in children.

10. Percutaneous transluminal renal angioplasty (PTRA) is usually the first revascularization option considered, particularly for short nonostial lesions of the main renal artery. Surgical revascularization, individualized based on extent and location of the renal artery disease, is appropriate for complex lesions or lesions in which PTRA has failed.

### Aortic Thrombosis

Although very rare, aortic thrombosis carries a high risk of morbidity and mortality. In the pediatric population, aortic thrombosis most commonly affects neonates, usually as a complication of umbilical artery catheterization. Studies have reported that a high percentage of neonates with an umbilical artery catheter develop some degree of arterial thrombosis, but only about 25% of these patients have resultant clinical symptoms. While the use of an umbilical artery catheter is the main predisposing condition in neonates with aortic thrombosis, 46% of affected neonates have multiple risk factors, including polycythemia, arrhythmias, a thrombophilic disorder, congenital heart disease, sepsis, dehydration, and maternal diabetes. In older children, spontaneous aortic thrombosis may occur in association with coarctation or other aortic pathology.

In patients with spontaneous aortic thrombosis, particularly in the absence of identifiable risk factors, it is imperative to perform a complete evaluation for possible coagulation disorders, such as antithrombin III, protein C, or ...

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